Humanism in oncology. What makes education in communication transformative?
Humanism in oncology. What makes education in communication transformative?
复制标题
DOI：
10.1080/08858190902854863
复制
发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Fryer-Edwards K
中科院分区：
文献类型：
--
作者：
Back AL;Arnold RM;Baile WF;Tulsky JA;Fryer-Edwards K
安东尼·L. BACK，MD，ROBERT M. Arnold，MD，WALTER F. BAILE，MD，JAMES A.塔斯基，医学博士，凯莉·弗雷尔·爱德华兹，博士在我们多年的沟通技巧教学中，我们也有过失败的经历。但我们也取得了远远超出我们预期的成功，对学习者产生催化作用的干预措施使他们改变和更新。医学文献对这类高峰期的学习经历几乎没有提及。然而，当我们与其他有成就的教育工作者谈论对他们来说真正重要的工作时，这些都是他们谈论的时刻。1，2在我们的经验中，这些催化事件是一种学习，它创造了那些在工作中探索人文方面的医生，对人有好奇心的医生，以及建立促进愈合的关系的能力。事实上，这种学习经历可以是变革性的。教师可以做些什么来鼓励转化型学习？在这篇文章中，我们描述了4个基本的设计原则，这将有助于创造一个环境，在这种增长可以发生。我们所说的转换是指学习者带走的不仅仅是另一个事实，甚至是技能的集合;他们离开时会有一种新的思考工作的方式。他们承担着一种使命，一种对自己的工作应该完成什么的感觉，这种感觉比态度的转变要大得多。在我们的一个交流研讨会之后，一个研究员回家在诊所里尝试了她对情绪反应的新技巧。第一个病人惊讶地对她说：“从来没有医生这样对我说话”--这段经历改变了她对肿瘤学家工作的看法。在研讨会上，我们主要关注的是技能，不想显得太“敏感”。我们没有想到的是，通过练习这些技能，她改变了她作为一名医生的方式。正如亚里士多德所说，道德实践塑造了我们的性格。通过走路，一个人变成了另一个人。我们也会说同样的沟通技巧：练习同理心创造了一种新的思考方式关于医生。我们在理解什么产生变革教育的集体经验是基于2个相关的项目，都由国家癌症研究所资助：Oncotalk和Oncotalk Teach。Oncotalk是2002年至2007年为医学肿瘤学研究员举办的为期4天的全国强化沟通技能务虚会。3在Oncotalk中，我们开发了一个用于教授沟通技能的住宅研讨会，其核心是技能实践，模拟患者在小组中被一系列正式和非正式的反思经验所包围。我们收集的结果表明，Oncotalk干预导致了沟通行为的可测量变化。[4]我们没有想到的是，这个项目改变了许多研究员对他们与病人关系的看法。他们撰写文章，教授其他学习者，并创建了一个新的肿瘤学家社交网络，致力于将沟通作为其工作的基本组成部分。5 Oncotalk Teach是一个持续的教师发展项目，旨在将我们在Oncotalk中确定的教学实践转化为不同的教学情况。虽然Oncotalk的教学是在专业工作室进行的，但大多数沟通教学发生在门诊和住院轮换期间。Oncotalk Teach专注于让教师在这些实时接触中更有效地教授沟通。6 Oncotalk和Oncotalk Teach的根本区别在于通信涉及两种数据：
ANTHONY L. BACK, MD, ROBERT M. ARNOLD, MD, WALTER F. BAILE, MD, JAMES A. TULSKY, MD, KELLY FRYER-EDWARDS, PHD n our years of teaching communication skills, we have had our share of duds. But we have also had successes that went far beyond our expectations, interventions that had a catalytic effect on learners—leaving them changed and renewed. The medical literature has little to say about these kinds of peak learning experiences. Yet when we talk to other accomplished educators about the work that really matters to them, these are the moments they talk about. 1, 2 In our experience, these catalytic events are the kind of learning that creates physicians who plumb the humanistic aspects of their work, physicians who have a curiosity about people and a capacity to build relationships that foster healing. In fact, such learning experiences can be transformational. What can a teacher to do encourage transformational learning? In this essay, we describe 4 essential design principles that will help create an environment in which such growth can occur. What we mean by transformational is that learners take away more than another factoid or even collection of skills; they leave with a new way of thinking about their work. They take on a mission, a sense of what their work should accomplish that is much larger than a shift in attitude. After 1 of our communication workshops, 1 fellow went home and tried out, in clinic, her new skills in responding to emotion. The very first patient said to her, surprised,“no doctor has ever talked to me like this”—and the experience changed how she thought of her work as an oncologist. In the workshop, we had focused primarily on skills, not wanting to seem too “touchy feely.” What we did not anticipate was that through practicing the skills, she changed her way of being a physician. As Aristotle might say, moral practice shapes our character. By walking the walk, one becomes a different person. We would say the same for communication skills: Practicing empathy creates a new way of thinking about doctoring.Our collective experience in understanding what engenders transformative education is based on 2 linked projects, both funded by the National Cancer Institute: Oncotalk and Oncotalk Teach. Oncotalk was a 4-day national intensive communication skills retreat for Medical Oncology fellows that ran from 2002 to 2007. 3 In Oncotalk, we developed a residential workshop for teaching communication skills, with a core of skills practice with simulated patients in small groups surrounded by a series of reflective experiences, both formal and informal. The outcomes we collected indicated that the Oncotalk intervention resulted in measurable changes in communication behaviors. 4 What we did not expect is that the project changed how many of these fellows viewed their relationships with patients. They have written articles, taught other learners, and created a new social network of oncologists committed to communication as a fundamental part of their work. 5 Oncotalk Teach is an ongoing faculty development project intended to translate the teaching practices we identified in Oncotalk for a different teaching situation. Although the teaching in Oncotalk was done in specialized workshops, most communication teaching occurs during outpatient clinic and inpatient rotations. Oncotalk Teach focuses on equipping faculty to teach communication more effectively in these real-time encounters. 6 The fundamental distinction in Oncotalk and Oncotalk Teach is that communication involves 2 kinds of data:
登录
查看更多内容
影响因子：
2.8
作者：
Robinson, Katya;Sutton, Sharyn;Emanuel, Linda L
通讯作者：
Emanuel, Linda L
影响因子：
5.7
作者：
Sullivan, Amy M.;Lakoma, Matthew D.;Block, Susan D.
通讯作者：
Block, Susan D.
影响因子：
45.3
作者：
Back, AL;Arnold, RM;Fryer-Edwards, KA
通讯作者：
Fryer-Edwards, KA
影响因子：
--
作者：
Back, Anthony L.;Arnold, Robert M.;Tulsky, James A.
通讯作者：
Tulsky, James A.
影响因子：
45.3
作者：
Francis, Lanie K.
通讯作者：
Francis, Lanie K.